Cranial neuropathy due to intradural disc herniation

Area of Science:

• Neurology
• Neurosurgery
• Spinal Surgery

Background:

• Herniated intervertebral discs rarely penetrate the thecal sac.
• Intracranial hypotension from penetrating disc fragments is exceptionally uncommon.

Observation:

• A 45-year-old man developed positional headaches, blurred vision, and bilateral lateral gaze palsies after a back injury.
• Brain MRI revealed signs of intracranial hypotension, including subdural collections and cerebellar tonsillar herniation.
• Spinal MRI and myelography confirmed an intradural herniated T12-L1 disc fragment causing a cerebrospinal fluid leak.

Findings:

• The patient's symptoms were attributed to intracranial hypotension secondary to an intradural herniated disc.
• Surgical excision of the disc fragment and dural repair led to complete resolution of the cranial neuropathy.

Implications:

• This case represents the first reported instance of cranial neuropathy due to an intradural herniated disc fragment.
• It underscores the sixth cranial nerve's vulnerability to pressure changes caused by cerebrospinal fluid leaks and intracranial hypotension.